Children hospitalized with severe acute respiratory syndrome-related illness in Toronto
Children hospitalized with severe acute respiratory syndrome-related illness in Toronto
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DOI：
10.1542/peds.112.4.e261
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发表时间：
2003-10-01
期刊：
影响因子：
8
通讯作者：
Read, S
中科院分区：
文献类型：
--
作者：
Bitnun, A;Allen, U;Read, S
目标。2003年2月至6月期间，大多伦多地区爆发了严重急性呼吸系统综合症。我们描述了在多伦多病童医院接受疑似或可能的sars诊断的儿童的临床、实验室和流行病学特征。建立了一项前瞻性调查研究方案，用于管理推定诊断为疑似或可能为SARS的儿童。根据他们的流行病学暴露、临床和放射学特征以及微生物学调查结果，所有人最终被分类为可能患有SARS、怀疑患有SARS或其他原因。25名儿童被纳入研究；10例为疑似SARS， 5例为疑似SARS，另有10例为其他病因。接触包括与11名儿童中至少1名可能患有SARS的成人直接接触，9名儿童从世界卫生组织指定的亚洲疫区旅行，以及在多伦多地区的一家医院就诊，该医院有5名儿童发生了继发性SARS传播。可能病例的主要临床表现为发热、咳嗽和鼻漏。除1名青少年外，所有儿童均未出现呼吸窘迫或缺氧，均完全康复。轻度局灶性肺泡浸润是主要的胸片异常。淋巴细胞减少;嗜中性白血球减少症;血小板减少症;部分病例丙氨酸转氨酶、天冬氨酸转氨酶和肌酸激酶升高。所有25名儿童的鼻咽拭子标本经内部逆转录聚合酶链反应均为sars相关冠状病毒阴性。我们的研究结果表明，SARS是一种相对轻微和非特异性的呼吸道疾病，在以前健康的幼儿中。不论儿童是否出现呼吸道症状，若出现发烧并有接触沙士的历史，应考虑将沙士作为可能的诊断。鼻咽标本的逆转录酶聚合酶链反应分析似乎对幼儿SARS早期症状期的诊断没有多大用处。
Objective. An outbreak of severe acute respiratory syndrome (SARS) occurred in the greater Toronto area between February and June 2003. We describe the clinical, laboratory, and epidemiologic features of children who were admitted to the Hospital for Sick Children, Toronto, with a presumptive diagnosis of suspect or probable SARS.Methods. A prospective investigational study protocol was established for the management of children with a presumptive diagnosis of suspect or probable SARS. All were ultimately classified as having probable SARS, suspect SARS, or another cause on the basis of their epidemiologic exposure, clinical and radiologic features, and results of microbiologic investigations.Results. Twenty-five children were included; 10 were classified as probable SARS and 5 were classified as suspect SARS, and in 10 another cause was identified. The exposure consisted of direct contact with at least 1 adult probable SARS case in 11 children, travel from a World Health Organization-designated affected area in Asia in 9 children, and presence in a Toronto area hospital in which secondary SARS spread had occurred in 5 children. The predominant clinical manifestations of probable cases were fever, cough, and rhinorrhea. With the exception of 1 teenager, none of the children developed respiratory distress or an oxygen requirement, and all made full recoveries. Mild focal alveolar infiltrates were the predominant chest radiograph abnormality. Lymphopenia; neutropenia; thrombocytopenia; and elevated alanine aminotransferase, aspartate aminotransferase, and creatine kinase were present in some cases. Nasopharyngeal swab specimens were negative for the SARS-associated coronavirus by an in-house reverse transcriptase-polymerase chain reaction in all 25 children.Conclusions. Our results indicate that SARS is a relatively mild and nonspecific respiratory illness in previously healthy young children. The presence of fever in conjunction with a SARS exposure history should prompt one to consider SARS as a possible diagnosis in children irrespective of the presence or absence of respiratory symptoms. Reverse-transcriptase polymerase chain reaction analysis of nasopharyngeal specimens seems to be of little utility for the diagnosis of SARS during the early symptomatic phase of this illness in young children.